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Neighborhood and Individual Disparities in Community-Based Naloxone Access for Opioid Overdose Prevention

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Abstract

Improving access to naloxone for laypersons is a cornerstone of the US strategy to reduce opioid overdose deaths. This study evaluated change in distance to opioid overdose prevention programs (OOPPs) providing walk-in naloxone across two time points. We also explored individual and neighborhood disparities in distance to OOPPs, associations between 2020 OOPP locations and 2018 overdoses, and associations between OOPPs and neighborhood fatal overdose rates. Using fatal opioid overdose locations in 2018 (n = 1167) and 2020 (n = 2045) in New York City, we mapped OOPP locations and fatal overdose locations to visualize areas of unmet naloxone need. We used logistic regression to assess individual (age, sex, race/ethnicity) and neighborhood correlates of odds of an overdose occurring within walking distance (≤ 0.5 miles or 0.8 km) of an OOPP and negative binomial regression to assess the relationship between census tract-level OOPP counts and overdose rates. Distance to OOPPs significantly improved over time, with average distance decreasing by 1.7 miles (2.7 km) (p < 0.001). OOPPs were more likely to be located in neighborhoods with higher poverty in both years and in closer proximity to Latinos in 2020—suggesting improved access for Latinos and in higher poverty neighborhoods. OOPP locations in 2020 were significantly positively associated with overdose locations in 2018. OOPPs were not well-situated in neighborhoods with elevated overdose rates in 2018 but were better situated in 2020, controlling for other neighborhood variables. Community lay naloxone access through OOPPs improved over time and could have promising effects for improved overdose rates in the future.

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Data Availability

Fatal overdose data are proprietary and available from New York City Office of the Chief Medical Examiner at their discretion.

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Acknowledgements

This work was supported by the National Institute on Drug Abuse (grant number K01DA049900). The authors thank New York City Office of the Chief Medical Examiner for providing fatal overdose data.

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Authors and Affiliations

  1. Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA, 19104, USA

    Elizabeth D. Nesoff

  2. Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA, 19104, USA

    Zachary F. Meisel

  3. Brown University, 75 Waterman Street, Providence, RI, 02912, USA

    Huda Saeed

  4. Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W168th St, 5th Floor, New York, NY, 10032, USA

    Silvia S. Martins

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  1. Elizabeth D. Nesoff
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Contributions

EDN: conceptualization, methodology, supervision, formal analysis, writing—original and draft. HS: formal analysis, writing—original and draft. ZFM: writing—review and editing. SSM: methodology, writing—review an editing.

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Correspondence to Elizabeth D. Nesoff.

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Nesoff, E.D., Meisel, Z.F., Saeed, H. et al. Neighborhood and Individual Disparities in Community-Based Naloxone Access for Opioid Overdose Prevention. J Urban Health 101, 64–74 (2024). https://doi.org/10.1007/s11524-023-00821-z

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